Mobile
Office Products
Printable Order Form
Please
print this form, provide all information requested, and return by
fax or regular mail.
Fax to: 423-775-0611. Mail to: Interactive Products Corporation,
148 Bluff Road, Dayton, TN 37321.
Please
Note: We
DO NOT accept personal checks.
We DO accept money orders.
Customer
Billing Information |
|
Name: |
_________________________________________________________ |
|
Company
Name: |
_________________________________________________________ |
|
Bill
to Address:
*Address must
be as
it appears on your
credit card statement
|
________________________________________________________ |
| _________________________________________________________ |
| _________________________________________________________ |
|
City: |
_________________________________________________________ |
|
State: |
________________________ |
Postal
Code: |
___________________ |
|
Country: |
________________________ |
|
Phone: |
________________________ |
E-mail: |
___________________ |
|
|
|
Customer
Shipping Information |
|
|
|
___
Check here if the Ship To Address is the same as the Bill To Address |
|
|
|
|
Name:
|
_________________________________________________________ |
|
Company
Name:
|
_________________________________________________________ |
|
Ship
to Address: |
_________________________________________________________ |
| |
_________________________________________________________ |
| |
_________________________________________________________ |
|
City: |
_________________________________________________________ |
|
State: |
________________________ |
Postal
Code: |
___________________ |
|
Country: |
________________________ |
|
|
| |
|
|
Credit
Card Information |
|
We
accept Visa, Master Card, Discover and American Express. |
| |
|
|
Card
Number: |
__________________________
|
|
Expiration
Date: |
_______________
|
| |
|
|
Mobile
Office Product Information |
| Quantity: |
Size: |
Description: |
Item
Number: |
| _______ |
____ |
_________________________________ |
_________________ |
| _______ |
____ |
_________________________________ |
_________________ |
| _______ |
____ |
_________________________________ |
_________________ |
| _______ |
____ |
_________________________________ |
_________________ |
| _______ |
____ |
_________________________________ |
_________________ |
| _______ |
____ |
_________________________________ |
_________________ |
